<!DOCTYPE html>
<html>
<meta charset="utf-8">
<head th:include="include :: header">
	<link rel="stylesheet" href="/js/plugins/layer/laydate/skins/default/laydate.css" />
</head>
<body class="gray-bg">
	<div class="wrapper wrapper-content ">
		<div class="row">
			<div class="col-sm-12">
				<div class="ibox float-e-margins">
					<div class="ibox-content">
						<form class="form-horizontal m-t" id="signupForm">
							<!-- <fieldset class="layui-elem-field layui-field-title"
								style="margin-top: 20px;">
								<legend>客户信息</legend>
							</fieldset> -->
							<blockquote class="layui-elem-quote">客户信息</blockquote>
							<div class="form-group" th:if="${user4ss != null}">
								<label class="col-sm-3 control-label"><em style="color:red">*</em>请选择4S店：</label>
								<div class="col-sm-8">
									<select class="form-control selectpicker" id="userId" name="userId" data-live-search="true">
										<option value="">-- 请选择 --</option>
										<option  th:each="item:${user4ss}" th:value="${item.userId}" th:text="${item.name}"></option>
									</select>
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label"><em style="color:red">*</em>车主姓名：</label>
								<div class="col-sm-8">
									<input id="carHolderName" name="carHolderName"
										class="form-control" type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label"><em style="color:red">*</em>车主身份证号：</label>
								<div class="col-sm-8">
									<input id="carHolderIdcard" name="carHolderIdcard"
										class="form-control" type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label"><em style="color:red">*</em>移动电话：</label>
								<div class="col-sm-8">
									<input id="carHolderPhone" name="carHolderPhone"
										class="form-control" type="phone">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">固定电话：</label>
								<div class="col-sm-8">
									<input id="carHolderContact" name="carHolderContact"
										class="form-control" type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label"><em style="color:red">*</em>联系地址：</label>
								<div class="col-sm-8">
									<input id="carHolderAddress" name="carHolderAddress"
										class="form-control" type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label"><em style="color:red">*</em>保单期限：</label>
								<div class="col-sm-8">
									<select class="form-control selectpicker" id="bdValid" name="bdValid" data-live-search="true">
										<option value="">-- 请选择 --</option>
										<option  th:each="item:${bdValidList}" th:value="${item.value}" th:text="${item.name}"></option>
									</select>
								</div>
							</div>
							
							<!-- <fieldset class="layui-elem-field layui-field-title"
								style="margin-top: 20px;">
								<legend>车辆信息</legend>
							</fieldset> -->
							<blockquote class="layui-elem-quote">车辆信息</blockquote>
							<div class="form-group">
								<label class="col-sm-3 control-label"><em style="color:red">*</em>VIN编码：</label>
								<div class="col-sm-8">
									<input id="vinCode" name="vinCode" class="form-control" placeholder="车辆大架子号"
										type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label"><em style="color:red">*</em>发动机号：</label>
								<div class="col-sm-8">
									<input id="egineNo" name="egineNo" class="form-control"
										type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label"><em style="color:red">*</em>车辆厂牌：</label>
								<div class="col-sm-8">
									<input id="carSupplier" name="carSupplier" class="form-control"
										type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label"><em style="color:red">*</em>车辆型号：</label>
								<div class="col-sm-8">
									<input id="carTypeNo" name="carTypeNo" class="form-control"
										type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">购车类型：</label>
								<div class="col-sm-8">
									<select class="form-control selectpicker" id="carBuyType" name="carBuyType" data-live-search="true">
										<option value="">-- 请选择 --</option>
										<option  th:each="item:${buyTypeList}" th:value="${item.value}" th:text="${item.name}"></option>
									</select>
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">销售顾问：</label>
								<div class="col-sm-8">
									<input id="carSaler" name="carSaler" class="form-control"
										type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">车辆登记日期：</label>
								<div class="col-sm-8">
								    <input type="text" class="laydate-icon layer-date form-control" 
								    		id="carRegistrationDate" 
								    		name="carRegistrationDate"
                                           	onclick="laydate({istime: true, format: 'YYYY-MM-DD'})" 
                                           	style="background-color: #fff;" readonly="readonly"/>
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">车牌号：</label>
								<div class="col-sm-8">
									<input id="carCode" name="carCode" class="form-control"
										type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">新车价格：</label>
								<div class="col-sm-8">
									<input id="carPrice" name="carPrice" class="form-control"
										type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">第一受益人：</label>
								<div class="col-sm-8">
									<input id="carBelong" name="carBelong" class="form-control"
										type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label"><em style="color:red">*</em>产品编号：</label>
								<div class="col-sm-8">
									<input id="productNo" name="productNo" class="form-control"  placeholder="GPS终端卡号"
										type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label"><em style="color:red">*</em>安装日期：</label>
								<div class="col-sm-8">
								    <input type="text" class="laydate-icon layer-date form-control" 
								    		id="bdStartDate" 
								    		name="bdStartDate"
                                           	onclick="laydate({istime: true, format: 'YYYY-MM-DD hh:mm:ss'})" 
                                           	style="background-color: #fff;" readonly="readonly"/>
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">安装地点：</label>
								<div class="col-sm-8">
									<input id="position" name="position" class="form-control"
										type="text">
								</div>
							</div>
							<div class="form-group">
								<label class="col-sm-3 control-label">安装人员：</label>
								<div class="col-sm-8">
									<input id="bdStartBy" name="bdStartBy" class="form-control"
										type="text">
								</div>
							</div>
							<div class="form-group">
								<div class="col-sm-8 col-sm-offset-3">
									<button type="submit" class="btn btn-primary">提交</button>
								</div>
							</div>
						</form>
					</div>
				</div>
			</div>
		</div>
	</div>
	<div th:include="include::footer"></div>
	<script type="text/javascript" src="/js/appjs/sz/bd/add.js"></script>
	<script type="text/javascript" src="/js/plugins/layer/laydate/laydate.js" ></script>
	<script type="text/javascript" src="/js/plugins/distpicker/distpicker.data.min.js"></script>
	<script type="text/javascript" src="/js/plugins/distpicker/distpicker.min.js"></script>
</body>
</html>
